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High-sensitivity troponin testing months after an acute coronary syndrome: noise or notable results
  1. Peter Kavsak1,
  2. PJ Devereaux2
  1. 1 Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
  2. 2 Health Research, Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Peter Kavsak, Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8V 1C3, Canada; kavsakp{at}

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High-sensitivity cardiac troponin testing has received much hype over the last decade. Substantial focus on high-sensitivity cardiac troponin testing has occurred due to the combination of diagnostic company marketing, different labelling requirements across regulatory bodies and investigators and journals using different terminology.1 There is a need for agreement on what constitutes a high-sensitivity cardiac troponin assay.1 2 This is not a trivial point, as publications in influential journals still misclassify cardiac troponin assays and their clinical use, despite laboratory recommendations providing some guidance in this area.1 2

So what is a high-sensitivity cardiac troponin assay? The current classification is subjective with the main criterion being that the concentrations are detectable in at least 50% of a healthy population.1 This qualitative approach for classification based on analytical sensitivity has met some resistance; however, it is important to emphasise that this is the first step in developing more rigorous criteria.1 Herein, incorporating clinical utility has the potential to further refine high-sensitivity cardiac troponin assays, and acute coronary syndromes (ACS) represents a crucial setting for refining this test’s characteristics.

Data from prototype assays, to investigational use, to regulatory-approved high-sensitivity cardiac troponin assays in both ACS and secondary prevention populations have demonstrated the ability to identify patients at both low and high risk for long-term cardiovascular outcomes.3–5 In these settings, the risk-stratification ability has been acknowledged, but important gaps remain on how to use high-sensitivity cardiac troponin testing after an ACS diagnosis to aid in patient management and possible treatment for secondary prevention.

In this issue of the Journal, Adamson and colleagues provide important evidence for the measurement of a high-sensitivity cardiac troponin assay months after an ACS diagnosis (ie, 1, 4 and 12 months post ACS).6 In nearly 1800 patients, at 4 months after an …

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